SummaryBackground and objectives With the advent of fetal screening ultrasonography, the detection of congenital anomalies of the kidney and urinary tract (CAKUT) in utero has permitted early management of these conditions. This study aims to describe the clinical course of a large cohort of patients with prenatally detected nephrouropathies.Design, setting, participants, & measurements In this retrospective cohort study, 822 patients were prenatally diagnosed with CAKUT and systematically followed up at a tertiary Renal Unit for a median time of 43 months. Variables included in the analysis were sex, laterality, fetal ultrasonography (isolated versus associated hydronephrosis), and presence/absence of nephrouropathies. The events of interest were urinary tract infection, surgical interventions, hypertension, CKD, and death. Survival analyses were performed to evaluate time until occurrence of the events of interest.Results Urinary tract infection occurred in 245 (29.8%) children, with higher risk in females (hazard ratio=1.30, 95% confidence interval=1.02-1.70, P=0.05); 22 patients (2.7%) had hypertension, and 49 (6%) patients developed CKD. The risk of CKD was greater in patients with associated hydronephrosis (hazard ratio=5.20, 95% confidence interval=2.90-9.30, P,0.001). Twelve patients (1.5%) died during follow-up. Death was significantly associated with being born during the first period of the study (hazard ratio=6.00, 95% confidence interval=1.60-22.50, P,0.001), associated hydronephrosis (hazard ratio=9.30, 95% confidence interval=2.90-29.30, P,0.001), and CKD (hazard ratio=170.00, 95% confidence interval=41.00-228.00, P,0.001).Conclusions In our series, the clinical course of prenatally detected CAKUT was heterogeneous, and those infants with associated hydronephrosis at baseline were identified as a high-risk subgroup.

Frailty is an important geriatric syndrome that results from a reduction in the reserves of multiple systems, leading to a state of increased vulnerability to stressors 1,2 . Frailty is generally associated with an increased risk of functional decline, institutionalization, hospitalization, and death 1-3 and has therefore been described as an important clinical and public health problem that merits further study 1 .Recent studies have identified an association between frailty and subsequent cognitive decline in 3-and 12-year cohorts 4,[6][7][8] . Moreover, associations have been found between frailty and an increased incidence of mild cognitive impairment 7 and Alzheimer's diease 6 . In a study involving frail older adults with and without cognitive impairment, Ávila-Funes et al. 5 report that cognitive impairment increases the predictive validity of frailty for the occurrence of adverse outcomes in a four-year period.Longitudinal studies report that the progression rate of cognitive impairment among older adults ranges from 1 to 2% a year 9 . Moreover, older adults with cognitive impairment progress to more severe stages on an annual basis and the conversion rate to dementia can reach 10 to 30% a year 10,11 . However, there is little knowledge on the factors related to progressive cognitive impairment within a one-year period and whether this progression is associated with frailty. Thus, gaining a better understanding of the association between frailty and cognitive impairment within a short period of time may assist in establishing strategies aimed at prevention and treatment.Study carried out at Universidade Federal de Minas Gerais (UFMG), Belo Horizonte MG, Brazil. AbstrActThe aim was to evaluate associations between frailty status and cognitive decline and the incidence of cognitive impairment over 12-month period. Two hundred seven older adults were assessed. Frailty was defined as having at least three of the following criteria: weight loss, weakness, exhaustion, slowness, and low level of activity. Cognitive decline was assessed using the Mini Mental State Examination (MMSE) and Clinical Dementia Rating Scale (CDR). Relative risk (RR) was calculated with a 95% confidence interval (CI). Frailty was associated with subsequent cognitive decline in 12-month when assessed using the MMSE (p=0.005; RR=4.6; 95%CI 1.93-11.2). No association was found between frailty and cognitive decline measured by the CDR (p=0.393; RR=2.1; 95%CI 0.68-6.7) or between frailty and the incidence of cognitive impairment (p=0.675; RR=1.2; 95%CI 0.18-8.3). These findings reveal an association between frailty and subsequent cognitive decline when measured by the MMSE, even within a short period of time.Key words: aged, frail elderly dementia.resumo O objetivo foi avaliar a associação entre fragilidade e o declínio cognitivo e a incidência de alteração cognitiva, em 12 meses. Foram avaliados 207 idosos. Fragilidade foi definida como ter pelo menos três dos critérios: perda de peso, fraqueza, exaustão, lentidão e baixo nível de atividad...

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Background: Measuring instruments should have their scientific and clinical value evaluated in different populations. The handgrip

was conducted by asking two raters to judge the transverse plane pelvic alignment and its reliability was assessed with the weighted kappa coefficient (k w ). The quantitative analysis was conducted by measuring the greatest pelvic tilt angle in transverse plane and its reliability was assessed by use of the intraclass correlation coefficient (ICC); the mean change, which was evaluated using 95%confidence interval of the mean difference (95%CI d) and Bland-Altman plot; and the quantification of measurement variability, which was assessed using standard error of measurement (SEM) and the coefficient of variation of the typical error (CV TE ). In addition, the minimal detectable change (MDC 95 ) was determined. Results: The intra-rater reliability ranged from fair to moderate (k w =0.32 to 0.58) and the inter-rater reliability was substantial (k w =0.80). The intra-test reliability was excellent (ICC=0.82), the 95%CI d ranged from -0.51º to 1.99º, the SEM was 2.38° and the CV TE was 28.75%. The MDC 95 was 6.59°. Conclusions: The inter-rater reliability was greater than the intra-rater reliability; the intra-test reliability was excellent and showed no systematic or random error.Keywords: pelvis; bridge test; core stability; reliability; physical therapy.